Comin' to America: Marburg Hemorrhagic Fever

I like this understated headline from the RockyMountainNews: "Rare Marburg hemorrhagic fever shows up in Denver". Well, golly gee! Of all the fevers you don't want to just show up on your doorstep, Marburg hemorrhagic is one of the rarest. In fact, this is the first reported case in the United States. The CDC's Dr. Pierre Rollin (seen here and here doing field work in Africa... and by the way, you don't expect the first search hit for an infectious disease doctor to be IMDB...) says the patient recovered fully. Apparently, the case was unconfirmed until just days ago (my guess is that since the incubation period isn't longer than two weeks, the CDC was waiting to make sure the infection was contained before making an announcement).

Maramagambo Python Cave

The AP article says the unidentified patient had been visiting #CDC photo removed# the "python cave" of Maramagambo Forest in Uganda and had come in contact with fruits bats. If you have any interest in hemorrhagic fevers, you will recognize that fruit bats are also the reservoir for Ebola, Marburg's cousin in theFiloviridae family, and the cave connection has been a feature of pop virology since at least The Hot Zone, which featured Kitum Cave. So why is it called the python cave, anyway?

I received a DMCA takedown notice from Blogger. Blogger set this post to "Draft" status so that it was no longer published on the web. Blogger's takedown notice didn't say what the offending material in this post was (!!), and, of this date, the notice has not been posted on ChillingEffects.org as Google's DMCA policy says it will be.

However, based on the comments section below, I'm guessing the complainant is a certain Flickr user who posted photos of a cave in Maramagambo Forest, so I'm removing his photo of the cave. That's a shame as it was a nicely illustrative photo. Complainants like this are sort of a pain. While within the letter of the law, the question of the ethics of reproducing a freely found photo is quite different. I was not obscuring authorship, I linked back to the photo's source, I don't get any financial gain of any sort from this blog, and the photo was originally published on the web for everyone to see for free.

The act of publishing in and of itself implies the intention for intellectual works to be disseminated to the public. (That's not just my idea but a component of American copyright law--it's why there is a public domain for things to eventually end up in.) So, to publish your work for free and then restrict its dissemination is sort of, um... well, how would you put it?

As an aside:Some commenters on this post were upset by the offhand way I say it was "stupid" to visit the cave (see below). I didn't mean so much to call the photographer, per se, stupid (as I don't know the circumstances of the photo and the photographer--for example, perhaps the photographer had never even heard of these sorts of viruses before visiting Uganda) as to call the whole business of visiting these caves a general stupidity. Commenters said, essentially, "hey, we're not stupid 'cause the photos were taken before the government said the fruit bats were a possible reservoir for the virus." I would like to point out, however, as The Hot Zone was published in the early 1990s and identified caves like this as a likely source of the virus, I find it impossible to believe there wasn't long-standing scientific speculation about these caves. This doesn't make specific tourists stupid, but it does make a case for the general stupidity of these cave visits.

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... stupid people! Actually, it's hard to imagine, but the [now removed] photos... were potentially taken within a few feet of a virus that could kill thousands or millions of people throughout America or Europe. In fact, the international community recognized this, and Uganda closed down tourism to the python cave after another tourist from The Netherlands brought Marburg back to Europe and died last summer.

A 2003 study in Emerging Infectious Diseases could identify only two risk factors for contracting Marburg. One was working as a miner and the other was receiving an injection. So, as long as a nurse doesn't have a needle-stick incident, contraction probably isn't too big a worry. In fact, of the all health care workers who were enrolled in the study, none had antibodies for Marburg: "Types of patient contact included administering injections (38%); cleaning up blood, vomitus, urine, or feces (28%); washing bed clothes (7%); washing corpses (6%); and receiving a needlestick injury (2%)."

VSV-G vaccines and tetherin

But what if you were a nurse who had a needle-stick incident? Well, right now you'd be screwed, I think. But maybe in the near future, there will be a prophylactic. Feldmann et al. (2007), working with the related Ebola virus, were able to protect monkeys from lethal doses of virus by using a post-exposure dose of vaccine created by integrating an Ebola glycoprotein into a vesicular stomatitis virus: "treatment is particularly suited for use in accidentally exposed individuals and in the control of secondary transmission during naturally occurring outbreaks or deliberate releases." And although Feldmann et al. were working with Ebola, Daddario-DiCaprio et al. (2006) produced a similar experiment using the Marburg glycoprotein. This 2006 study looked at the efficacy of this antigenic delivery method as a preventive vaccine, but since the 2007 study uses the same essential methodology in a post-exposure context, it seems highly likely that a post-exposure treatment for Marburg could be created as well.

An emerging treatment option that has just been published in February and March issues of Journal of Virology involves the use of tetherin (formerly CD317), a cellular component that keeps new virions from detaching from infected cells. (See some great photos of budding Ebola virus at PLoS Pathogens.) Two teams (Sakuma et al & Jouvenet et al) found that tetherin has specific action on a spectrum of viruses including Marburg. However, Vincent Racaniello over at virology blog recently blogged a PNAS article showing that Ebola glycoprotein inhibits tetherin activity on the cell surface.

6 comments:

Thanks for saying that my photos are great, but please in future ASK ME before using my photos and quoting me. Heck, if you'd asked me some questions, not only would I have given you permission to use my photos and words, I might even have been able to clarify some of your mistaken assumptions here.Marcus Richardson aka Simian

Hmmm...typical of bloggers to talk out of their asses for the sake of putting something up. Makes one wonder as to the veracity/accuracy of anything you write since you shot off at the mouth about Simian without knowing anything about the details. I think a correction would be in order?

So you don't intend to apologize for violating my legal rights then?It doesn't matter whether you get "kick-backs" or not. Using people's copyrighted photos on your website without permission is, to put it mildly, not cool. It doesn't matter that it's a blog and not a money-making site.And thanks so much for labelling me and others "stupid". May I return the compliment and point out that when I visited this cave, considerably earlier than the unfortunate incidents that later occurred, there was no indication whatsoever from the authorities there was any potential health risk. My visit was conducted under the auspicies of the official Ugandan wildife authorities. If I had ignored official warnings and visited, then yes I would have been stupid. But that wasn't the case. And I didn't even go inside the cave as such, just stood outside the mouth of the cave and shot my photos from there.Like I said, you could easily have contacted me via Flickr to ask permission to use my photos and to ask for more details of my experience and I would have been happy to oblige. Finally, if you still think it's OK to use my photo without permission, take a look at this discussion thread:http://www.flickr.com/help/forum/92370/?search=blog

OK I've waited over a month and haven't received a satisfactory response on this issue. Please remove my photo and all reference to me (Simian) in this post within the next 48 hours otherwise I will take further action. As I said before, I did NOT give you permission to use my photo and I consider your remarks about me insulting, inaccurate, and potentially libelous and I will take action if you do not delete them.

series

A series is a collection of related posts, sort of like a series of articles in a newspaper. It may be ongoing, or a short collection of only a few posts. When you click on a link, posts will appear in reverse-chronological order, so you need to go to the beginning if something doesn't make sense.

Books for Nurses : reviews of "extracurricular" reading I think would be good for nurses and other health care workers. These should improve understanding of medicine and health care, help improve job skills, or change the way you think about health issues. For a complete listing of media reviews, see the library tag.

The Sexy Nurse Report : series of posts juxtaposing the silly sexual images of nurses produced in the media with the unsexy reality of nursing work...

ResearchBlogging : series of posts focusing on scientific research that are cross-posted at the ResearchBlogging.org website. Also see my profile there.

Orientation & 1st Year of Nursing : series of posts relating to my entry into the nursing profession after nursing school: NCLEX exam, hospital orientation, newbe experiences on the job...

Nursing School : series of posts documenting my experience in nursing school. Most of the several hundred posts I have up are from while I was in nursing school, but this series are the ones that I wrote specifically about school while I was a student nurse.